Diaphragmatic hernia mimicking hydropneumothorax: common error in emergency department

Magu, Sarita; Agarwal, Shalini; Jain, Neetu; Dalal, Nityasha

doi:10.1136/bcr-2012-008547

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…It consists of both free fluid and air within the pleural space. In the pediatric population, hydropneumothorax has been associated with rupture of a diaphragmatic hernia, after thoracocentesis, and trauma and with infections such as tuberculosis [ 1 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of a diaphragmatic rupture requires a high index of clinical suspicion and careful look of the chest radiograph. Radiological features that suggest the possibility of a diaphragmatic rupture include elevated hemidiaphragm, irregular diaphragmatic outline, gas bubble in the chest, nasogastric tube in the chest, and compression atelectasis of the lower lobe [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Hydropneumothorax in Children: A Rare Complication of a Bacterial Pneumonia

Ortega

Gonzales

Soto-Martinez

et al. 2016

Case Reports in Pediatrics

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Hydropneumothorax is an uncommon presentation of a complicated pneumonia, and very few cases in the pediatric population have been reported. This is a case of a 5-month-old patient who presented to the emergency department (ED) with a three-day history of fever, diarrhea, and respiratory distress. His initial assessment suggested a lower respiratory tract infection and because of his respiratory distress and hypoxia a chest X-ray was performed. Other clinical information and radiologic studies will be discussed further, but his chest X-ray suggested a right-sided hydropneumothorax secondary to a complicated pneumonia. He completed 12 days of IV antibiotic treatment and required a chest tube for drainage. Patient was discharged home with a full recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hydropneumothorax in Children: A Rare Complication of a Bacterial Pneumonia

Ortega

Gonzales

Soto-Martinez

et al. 2016

Case Reports in Pediatrics

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“…The majority of those cases represented complications of traumatic DH with acute [13,14] or delayed presentation [15]. Several authors reported cases of incarcerated DH with gastrothorax with [13, 16,17] or without tension component [5,18]. A prolonged herniation of the stomach can result in a focal gangrene of stomach [16].…”

Section: Clinical Presentation Of Diaphragmatic Herniamentioning

confidence: 99%

“…Traumatic rupture is the main reason for DH and is found in up to 8% of the cases of major abdominal trauma (traffic accident, fall from height, barotrauma, stab wound) with a ratio of 3:1 for penetrating to blunt trauma [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Incarceration of a diaphragmatic hernia complicated by a tension fecopneumothorax after left hemihepatectomy: Review of the literature and case report

Scholtes¹,

Pochhammer²,

Schäffer³

2018

J Abdom Wall Reconstr

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Incarceration of abdominal organs in a diaphragmatic hernia is a potentially life-threatening condition. It is associated with significant morbidity and mortality. A successful management of this entity requires fast and correct diagnosis and prompt treatment.To our knowledge we report the first case of gastric incarceration in an iatrogenic diaphragmatic hernia with consequent intrathoracic perforation and tension pneumothorax.Etiological was an open left hemihepatectomy for a benign tumor in a 71-year old male. In a combined thoraco-abdominal approach we successfully sutured the diaphragmatic defect and resected the stomach fundus.In a comprehensive review of the literature we illustrate standards and pitfalls in diagnostics and treatment of diaphragmatic hernia in emergency setting. While most diaphragmatic hernias are congenital or posttraumatic, reports of iatrogenic diaphragmatic hernias are increasing. As an incarcerated diaphragmatic hernia is easy to miss, a high index of suspicion is necessary. Our case illustrates, that delayed presentation or diagnosis may lead to severe complications and that complicated diaphragmatic hernia present a big surgical challenge.

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A Hydropneumothorax That Never Was!

Kourouni

Parekh

Mathew

2021

Chest

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A 28-year-old female-to-male transgender patient with unknown medical history was brought to the ED after being found unresponsive in the street with a helmet on his head. Trauma code was activated for presumed traumatic event. He was afebrile with normal BP, however, and was bradycardic at 54 beats/min and hypoxemic to 90% oxygen saturation on ambient air. His respirations were unlabored at 16 breaths/min. The patient was comatose with Glasgow coma scale of 7. Lung auscultation revealed decreased breath sounds on the left hemithorax. He was noted to have faint thoracic scarring bilaterally, which was presumed to be from bilateral mastectomies, along with acute deep abrasions suggestive of friction injuries with a dominant left-sided distribution. Cardiac and abdominal examination was unremarkable. Due to audible oropharyngeal secretions and signs of vomit on his clothing, the decision was made to proceed with intubation for airway protection.CBC count, basic metabolic panel, urine, and serum toxicology testing that included alcohol and salicylate levels were unrevealing. CT scan of the head was negative for acute ischemic stroke or hemorrhage. A postintubation chest radiograph is shown in Figure 1. Extended focused assessment with sonography for trauma was negative for free intraabdominal fluid.Critical care consultation was requested for further evaluation and chest tube placement.

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Diaphragmatic hernia mimicking hydropneumothorax: common error in emergency department

Cited by 3 publications

References 10 publications

Hydropneumothorax in Children: A Rare Complication of a Bacterial Pneumonia

Hydropneumothorax in Children: A Rare Complication of a Bacterial Pneumonia

Incarceration of a diaphragmatic hernia complicated by a tension fecopneumothorax after left hemihepatectomy: Review of the literature and case report

A Hydropneumothorax That Never Was!

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